- Pneumothorax happens when air builds up between the lung and chest wall, which can cause the lung to collapse.
- Common symptoms include sudden chest pain, shortness of breath, difficulty breathing, and a persistent cough.
- Treatment focuses on removing trapped air, relieving pressure on the lung, and preventing pneumothorax from happening again.
Pneumothorax occurs when air accumulates in the pleural space, the area between the lungs and the chest wall. This buildup of air can lead to lung collapse.
Pneumothorax usually occurs after trauma, such as a penetrating chest injury. It can also happen after a car accident, as a result of a chronic disease, or, more rarely, without any clear cause.
Because pneumothorax can seriously affect breathing and even heart function, it should be evaluated right away at a hospital. Prompt diagnosis and treatment can help prevent complications.
Pneumothorax symptoms
The main symptoms of pneumothorax are:
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Sudden, severe chest pain that gets worse when breathing in
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Difficulty breathing
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Bluish skin, especially on the fingers and lips
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Increased heart rate
According to the American Lung Association, shortness of breath and one-sided chest pain are common signs of pneumothorax, although these symptoms can also occur with other respiratory conditions and should always be assessed by a pulmonologist.
Confirming a diagnosis
Pneumothorax is diagnosed by a pulmonologist or other healthcare provider based on an evaluation of symptoms, medical history, history of chest trauma, and physical and imaging exams.
A doctor may order tests such as a chest X-ray, CT scan, or, in some cases, ultrasound to confirm the diagnosis and help guide treatment.
Main causes
Pneumothorax can have several causes. Based on the cause, it is usually classified into four main types:
1. Primary pneumothorax
This occurs in people with no history of lung disease and no clear cause. It is more common in smokers and in people with a family history of pneumothorax.
Tall people and those between 15 and 34 years old also appear to have a higher risk of developing this type of pneumothorax.
2. Secondary pneumothorax
Secondary pneumothorax occurs as a complication of another disease, usually a pre-existing respiratory condition.
The most common lung diseases that can cause pneumothorax include COPD, cystic fibrosis, severe asthma, lung infections, and pulmonary fibrosis.
Other conditions that can also lead to pneumothorax, but are not directly related to the lungs, include rheumatoid arthritis, systemic sclerosis, and dermatomyositis, for example.
3. Traumatic pneumothorax
This is possibly the most common type of pneumothorax and happens after trauma to the chest area, such as deep cuts, rib fractures, or car accidents.
People who scuba dive can also develop this type of pneumothorax, especially if they rise to the surface too quickly due to pressure changes.
4. Tension pneumothorax
This is one of the most serious forms of pneumothorax. It happens when air moves from the lung into the pleural space but cannot return to the lung, causing air to gradually build up and create intense pressure on the lung.
Symptoms can worsen very quickly, making immediate hospital treatment essential.
Treatment options
Treatment for pneumothorax is typically managed by a pulmonologist or other hospital-based healthcare provider. The goal is to remove the excess air that has built up, relieve pressure on the lung, and allow it to expand again.
The main treatments for pneumothorax include:
1. Lung decompression
Lung decompression is performed by a pulmonologist by removing air with a needle inserted between the ribs, allowing the air to leave the body.
After this, the person needs to stay under observation to check whether the pneumothorax comes back, with regular exams.
2. Thoracotomy
Thoracotomy is a surgical procedure performed after lung decompression with a needle.
This type of treatment for pneumothorax involves placing a chest tube to continuously remove air or correcting any lung abnormality that is causing air to build up in the pleural space.
3. Pleurodesis
Pleurodesis is another surgical procedure mainly indicated for recurrent pneumothorax. It is performed by a pulmonologist to eliminate the pleural space and prevent air from building up.
It is also important to identify the correct cause of pneumothorax to determine whether any additional, specific treatment is needed for the underlying cause and to help prevent pneumothorax from happening again.
4. Video-assisted thoracoscopic surgery
Video-assisted thoracoscopic surgery (VATS) may be performed by a pulmonologist or thoracic surgeon to remove lung blebs or air sacs, a procedure called bullectomy.
During this surgery, mechanical pleurodesis or pleurectomy may also be performed to remove the parietal pleura.